Two residents at Sonoma Developmental Center are escorted down the hall.

Eighteen months after the state preliminarily decertified much of the Sonoma Developmental Center―caregiver for around 440 patients with cerebral palsy, severe autism and mental retardation―the other shoe has dropped.

The California Department of Public Health (CDPH) announced on Friday that seven of the center’s 11 units will lose their certification and federal funds, just as the other four did last year. But the center, located in Sonoma County’s Eldridge community, did not lose its state license and can stay open for now.

DDS has 90 days to appeal and trigger a process that could stretch into December. Medi-Cal, the state’s name for the federal Medicaid program it administers, pays around half of the $400,000 annual cost per patient and the loss of funding is problematic. Around 240 of the patients would be affected.

Most of the Sonoma center patients are incapable of living with families or in group homes. Sonoma is the state’s oldest developmentally disabled facility and had 3,500 patients in 1965. But a shift away from large institutions to smaller, more personal group homes has left the big facilities in limbo, under-funded and under-staffed.

Some of Sonoma’s patients have been there for 20 years.

Media and government investigations have turned up numerous instances of abuse and neglect. A report from the Public Health department in 2012 said: “Individuals have been abused, neglected, and otherwise mistreated and the facility has not taken steps to protect individuals and prevent reoccurrence. Individuals were subjected to the use of drugs or restraints without justification. Individual freedoms have been denied or restricted without justification.”

DDS Director Therese Delgadillo resigned last August for health reasons, one month after the California State Auditor released a scathing report (pdf) on the department’s in-house police force, called the Office of Protective Services (OPS). The report said the department was underfunded, ill-prepared and did a lousy job. The auditor noted that many of the 28 specific recommendations cited in a critical 2002 report from the California attorney general had gone unattended to, putting patients, employees and visitors at risk.